2.9 The failure of CAM therapeutic relationships: creating dependency to satisfy practitioners' emotional and financial needs
Although a failed therapeutic relationship is often assumed to involve a patient not returning, the case of a patient who attends repeatedly can also be highly problematic. This phenomenon can be seen as a breach of boundaries in that an inappropriately extended therapeutic relationship changes from being a healing encounter into a dependency relationship or friendship. Unlike the timescale contracts that may be negotiated in counselling and psychotherapy, there are no fixed timescales for most CAM therapies. Some CAM users will continue to attend as and when they feel like it, especially when the CAM therapies have a strong leisure or relaxation component, such as massage or aromatherapy. In the more ‘medicalised’ therapies, practitioners usually indicate to users the timescale in which they hope to see some improvement. Negotiating an appropriate timeframe helps patients to feel in control, and gives a realistic period in which to judge whether the treatment is beneficial.
Other CAM therapies are based on the notion of minimum intervention. For example, in osteopathy the general aim of the treatment is that patients are not long term. Once a lack of improvement or a levelling off is observed then the practitioner is expected to help the patient end the treatment. Of course, some patients will return for ‘top-up’ sessions, or when a condition flares up. However, research by the British School of Osteopathy suggests that returning patients are quite common (Pringle and Tyreman, 1993).
Practitioners are often at a loss to know where to send patients who report they are not getting better. In some cases, practitioners think these patients have no one else to turn to and that they have an ongoing duty to relieve the patients’ distress, even though they cannot offer a cure. This raises interesting issues about what therapy is really for, and how attendance may be affected by lack of support or care for particular patient groups in orthodox services. Continually returning patients are the subject of a considerable literature in orthodox health care and they are often called ‘heart sink’ patients (for example, Pietroni and Chase, 1993; O'Rourke, 2000). The ‘returnee’ may be CAM's equivalent.